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Dougherty, M.

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Tetraflex accommodating iol The lens tetraflex accommodating iol was designed to take advantage of how the crystalline lens moves during accommodation according to the Helmholtz theory. Petersburg, FL is one of the exciting new technologies to which European surgeons, unlike most American surgeons, have access to as part of their surgical refractive armamentarium. Each one of the optics has an internal aspheric surface where its power increases linearly when the lens moves. Download references. When the ciliary muscle constricts, it redistributes its mass like any other muscle and encroaches on the vitreous cavity space, increasing the vitreous cavity pressure, moving the optic forward. So, some pseudoaccommodation probably occurrs.
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During accommodative effort, the ring haptics are brought together resulting in a forward axial movement of the optic with a resultant increase in the functional power of the lens. The HumanOptics 1CU is a hydrophilic, acrylic, foldable, single-piece lens with a biconvex square-edge optic and 4 modified flexible haptics that allow for forward movement of the optic during accommodative effort Figure 1.

Although other studies have demonstrated much higher degrees of accommodative amplitudes, unfavorable results among European ophthalmologists who have utilized this lens will in all likelihood impair its success in the general market. Image courtesy Burkhard Dick, MD. Figure 1. The Lenstec TetraFlex is a square-edged, acrylic IOL with closed-loop haptics designed to move forward during accommodative effort.

The lens is currently undergoing FDA clinical trials. There are currently no peer-reviewed publications to substantiate these promising reports. The eyeonics crystalens is a One of the consistent findings in accommodative IOL studies is a disconnect between the measured axial movement of the IOLs and the unaided near acuities. In most studies, axial lens movement is much smaller than would be expected for the functional near vision outcomes.

Marchini et al reported the mean anterior axial movement of 20 crystalens IOLs to be only 0. Yet, despite a mean accommodative amplitude of 1. Image courtesy Richard S. Hoffman, MD, I. Figure 2. Crystalens accommodating IOL in situ. These findings suggest that the accommodating crystalens is a viable alternative to multifocal IOLs in the appropriate patient.

Both of these IOLs utilize a positively powered biconvex front lens connected to a negatively powered concave-convex lens. During accommodative effort, the 2 lens components increase their distance from each other, resulting in increased effective power of the overall lens. The dual-optic design offers potential advantages over single-optic designs in that less lens excursion is necessary with the dual-optic in order to achieve a desired amount of accommodation Figure 3 Br J Ophthalmol.

Investigators in South America and Europe have reported favorable results with the Visiogen Synchrony Figure 4 , measuring accommodative amplitudes between 0. Courtesy Visiogen Figure 3. Relative accommodative amplitudes with associated forward IOL movement of 19 D.

Image courtesy Visiogen. Figure 4. The dual-optic Synchrony accommodating IOL. These types of lenses change their true power during accommodation, and hold the promise of providing higher amplitudes of power change than can be currently achieved with single and dual-optic accommodating lenses. Deformable IOLs are, for the most part, in the preliminary stages of development and animal research. The lens is unique, because it is packaged as a thin, solid rod that can be inserted into the eye at room temperature through a microincision Figure 5.

After being placed in the aqueous at body temperature, the Medennium Smart IOL transforms into a soft gel that completely fills the capsular bag and maintains some elasticity. Courtesy Medennium Figure 5. The AMO FlexOptic IOL is an accommodating IOL that fills or conforms to the capsular bag and is designed to increase its anterior radius of curvature and true power in addition to changing its position in the capsular bag during accommodative effort. The NuLens accommodating IOL is designed to change its true power during accommodation and has been shown in an animal model to deliver over 40 D of accommodation.

The NuLens incorporates a small chamber of silicone gel and a posterior piston with an aperture in its center that allows the gel to bulge relative to the forces generated by accommodation Figure 6. The lens has been implanted in primates with encouraging results and is currently undergoing laboratory research and refinement before human studies are initiated.

The Power Vision FluidVision IOL is designed to change its shape and true power through a series of microscopic hydraulic actuators that are indirectly controlled by contraction and relaxation of the ciliary muscle Figure 7. The lens is projected to deliver more than 10 D of power change. Some people, however, still prefer to wear glasses for extended periods of reading or other close-up activities. Accommodation is an important process that allows the eye to focus on things at varying distances.

Over the course of life, the hardness or stiffness of the lens increases more than 1, times, greatly impacting its ability to change shape well. Around the age of 40, which is when many age-related eye conditions start to appear, the lens exhibits a clinically significant reduction in accommodation. Researchers believe that the stiffening of the lens as one gets older is the main cause of presbyopia, also known as the loss of accommodation.

There are a few different types of IOLs that have been developed for different purposes. Accommodating IOLs provide a good treatment option for people who need a high level of visual performance. Benefits of accommodating IOLs include:. The design and material of accommodating IOLs make them very effective at improving accommodation with little or no side effects.

Accommodating IOLs can greatly increase your quality of vision and reduce your dependence on glasses, but there are still some drawbacks. More research is needed to confirm the long-term effects and efficacy of accommodating IOLs, but so far, the results are promising. Though there are a few potential drawbacks of accommodating IOLs, negative side effects can quickly be addressed after surgery. The cost of accommodating IOLs can be an additional drawback for some people.

They are a premium type of lens that requires customization, so they are naturally more expensive than monofocal or even multifocal lenses. Many insurance providers, including Medicaid, cover a percentage of the cost of procedures like cataract surgery. The remaining percentage, or copay, becomes an out-of-pocket cost for the patient. Accommodating IOLs were developed to improve the outcomes of cataract surgery and to help patients with presbyopia regain clear close vision without compromising any of their long-distance vision.

Researchers agree, however, that more controlled studies are needed to confirm the efficacy of accommodating IOLs and to discover how to make them even more effective. Accommodating IOLs have a promising future, as they are a treatment for presbyopia , not just compensation. They are able to restore accommodation in the eye, which is the primary function lost through presbyopia. Not all accommodating IOLs have been entirely effective in the past, however, so their use is still somewhat controversial.

Multiple independent researchers have reported the results of accommodating IOLs as modest in their ability to restore accommodation. Additionally, these benefits are sometimes lost over time due to changes in the capsular bag in which the lens is implanted. Because of these findings, the development of accommodating IOLs was nearly deserted a couple of years ago.

New insights, however, have led researchers to focus on new mechanisms of action to better utilize the potential of accommodating IOLs. Doctors in the U. As the FDA continues to review the data on accommodating IOLs, scientists are working on new ways to implant the lenses to make them more reliable and just as safe as any other type of IOL. American Academy of Ophthalmology. Accommodative IOLs: Feasible?

September Ophthalmology Times: Europe. June Eye and Vision: BioMed Central.

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In addition, the anterior surface of the optic curves more than the posterior surface during anterior vaulting of the lens. This higher radius of curvature of the lens' anterior surface increases the net refractive power of the lens as well as induces coma. The later is an important part of the normal accommodative process in the prepresbyopic phakic eye.

The accommodative effect of the lens may be seen using three-dimensional ray tracing, which shows increased depth of focus and mean and maximum myopia in eyes implanted with the Tetraflex during the accommodative effort D. Sanders, MD, oral communication, December Figure 4. To date, more than lenses have been implanted in this country, with 53 of eyes having 6 months or more of follow-up data on file with Lenstec, Inc.

In terms of evaluating the near performance of any presbyopic lens, distance-corrected near vision is considered the gold standard. Fifty-five percent of eyes demonstrated a monocular distance-corrected near vision of J5 print size of stock quotes or better, and 90 have a distance-corrected near vision of J8 standard newspaper print or better. European data of near visual function show that the near performance of Tetraflex is even better when the lens is implanted bilaterally versus monocularly data on file with Lenstec, Inc.

In terms of accommodative amplitude in the FDA study, of eyes had at least 2. Currently, none of the patients implanted with the Tetraflex, either domestically or internationally, have experienced any capsular issues. My experience as a principal investigator in the FDA trial of this lens has been excellent.

So far, I have implanted 35 of these IOLs. The lens is simple to implant, has none of the visual side effects such as glare, halo, and loss of contrast sensitivity of multifocal lenses, and is consistently giving my patients functional near vision without correction. Because there is a single point of focus through all distances, the quality of vision through the lens is excellent. I consider this lens equivalent in distance performance to any monofocal lens that I use with the fringe benefit of improved near vision.

Like any accommodative lens, however, I do not promise that all patients will throw away their glasses. Some patients achieve lesser accommodative effect and may require near spectacles part of the time, particularly with low lighting and low-contrast print. I have found that patients with shorter axial lengths tend to have better subjective near vision with the Tetraflex than patients with longer axial lengths.

Although I have needed to perform a YAG posterior capsulotomy on only a few eyes after the IOL's implantation, the laser does not seem to negatively affect accommodation, and all lenses have remained in perfect position postoperatively. Many different lenses are available to treat presbyopia in the US, including both monofocal and multifocal IOLs. European surgeons have access to many exciting ophthalmic technologies not currently available here.

One of these, the Tetraflex IOL, shows significant promise in helping the surgeon to deal with the presbyopic patient. History of Ophthalmic Viscosurgical Devices. Prevention of Corneal Ectasia in Refractive Surgery. Aspheric Algorithms and Quality of Vision.

In the age of presbyopia-correcting IOLs, a surgeon now has the additional armor to offer patients the greatest care and visual outcomes. I currently use multifocal as well as accommodating IOLs in the treatment of presbyopia. I opt to use an accommodating IOL in patients who require prelex ie, refractive lens exchange , and I often use it as a routine in cataract patients. Petersburg, Florida to other accommodating lenses.

This IOLs provides patients with excellent distance and intermediate vision as well as useful near vision. It appears that the IOL does not have to move as much as you would predict to get the increased power. So, some pseudoaccommodation probably occurrs. This haptic design works with vitreous movement and ciliary swelling in the eye to create clear near vision through maximum forward movement and a swift return to the flat position for clear intermediate and distance vision.

Its square edge optic helps reduce posterior capsule opacification as well as other common cataract complications. One advantage of the Tetraflex is that the learning curve is practically nonexistent, and I have had good results thus far.

This microincisional lens has a 5. In the patients I have implanted with the Tetraflex, only one patient complained of halos. This is much less than you find with multifocal IOLs. It is best used in emmetropic and hyperopic patients who have realistic expectations. Patients who are more interested in having better distance and intermediate vision, and who are not too concerned about being able to read the tiniest print, are the likely candidate for an accommodating lens.

Patients with severe dry eye; ocular infection; severe ophthalmic diseases ie, macular disease, uveitis, glaucoma, or retinal disease ; uncontrolled systemic diseases eg, diabetes, hypertension, or cardiovascular disease ; or those with 1. If a patient is concerned with reading tiny print, or if they need good near vision as a requirement for their job, I will alternatively implant a multifocal IOL.

These lenses offer the best near vision, at the sacrifice of intermediate vision. Therefore, in general, I use the Tetraflex Presbyopic IOL, when appropriate, in patients who either have routine cataract surgery, or are having refractive lens exchange. I have a good amount of experience with all types of IOLs. I am finding that I treat the same approximate number of patients with the Tetraflex as I would with a regular multifocal.

There is not much difficulty in the surgical technique, and it is also a very easy lens to load in the injector system.

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Dougherty couldn't reveal a price of the Tetraflex yet, but did indicate it should be treated as a premium IOL and priced as such. All have varying diopters of accommodation, with the NuLens expecting to have a 4 D to 8 D range and the Synchrony from 1.

Variability is related to ciliary body action, age, anatomic issues related to the capsule, and capsular bag fibrosis. The AkkoLens has been used in a handful of European patients with "very promising" but confidential outcomes thus far, said Dr. For truly unique technology, look no further than the Elenza lens, the first electrically activated IOL.

The lens is purely experimental so far and will stay that way for some time, but still provides a fascinating glimpse into the future. It's not only about the lens, but the technology being used; it is so sophisticated that it might lead to a cascade of intraocular devices, which would be perfect to measure variations in intraocular disease, IOP on a real basis, and many other issues. All three of these lenses are years away from reaching U.

Synchrony is a dual-optic accommodating IOL that uses a preloaded disposable injector allowing for controlled implantation into the bag. Currently, the incision needs to be around 3. Studies have shown that SIA stabilizes within.

Furthermore, making a circular and centered capsulorhexis of less than 5 mm is crucial; if it's too big the lens won't be retained in the bag. The company has done a brilliant job of creating an injector system that, at the time of approval, will probably go into an incision less than 3 mm in size, but you have to have some faith that the lens will unfold the way it's designed to.

Not all surgeons are ready for that. It will be well suited for femtosecond laser surgery. Dougherty agreed. For the average surgeon, it's going to be a much more challenging lens. The technology is sure to develop and evolve between now and when most of these lenses are approved.

Editors' note : Dr. Dougherty has a financial interest with Lenstec. Contact information Ali : jlalio vissum. Skip to main content. All Years I opt to use an accommodating IOL in patients who require prelex ie, refractive lens exchange , and I often use it as a routine in cataract patients. Petersburg, Florida to other accommodating lenses. This IOLs provides patients with excellent distance and intermediate vision as well as useful near vision. It appears that the IOL does not have to move as much as you would predict to get the increased power.

So, some pseudoaccommodation probably occurrs. This haptic design works with vitreous movement and ciliary swelling in the eye to create clear near vision through maximum forward movement and a swift return to the flat position for clear intermediate and distance vision. Its square edge optic helps reduce posterior capsule opacification as well as other common cataract complications.

One advantage of the Tetraflex is that the learning curve is practically nonexistent, and I have had good results thus far. This microincisional lens has a 5. In the patients I have implanted with the Tetraflex, only one patient complained of halos. This is much less than you find with multifocal IOLs. It is best used in emmetropic and hyperopic patients who have realistic expectations. Patients who are more interested in having better distance and intermediate vision, and who are not too concerned about being able to read the tiniest print, are the likely candidate for an accommodating lens.

Patients with severe dry eye; ocular infection; severe ophthalmic diseases ie, macular disease, uveitis, glaucoma, or retinal disease ; uncontrolled systemic diseases eg, diabetes, hypertension, or cardiovascular disease ; or those with 1. If a patient is concerned with reading tiny print, or if they need good near vision as a requirement for their job, I will alternatively implant a multifocal IOL.

These lenses offer the best near vision, at the sacrifice of intermediate vision. Therefore, in general, I use the Tetraflex Presbyopic IOL, when appropriate, in patients who either have routine cataract surgery, or are having refractive lens exchange. I have a good amount of experience with all types of IOLs. I am finding that I treat the same approximate number of patients with the Tetraflex as I would with a regular multifocal.

There is not much difficulty in the surgical technique, and it is also a very easy lens to load in the injector system. This is not the case with accommodating IOLs, however, I have noticed additional success in patients who complete accommodating exercises. These patients may accomplish J4. During these exercises, the patient covers their nonoperated eye, or if they have both eyes done, they use both eyes. First, the patient finds the ideal space for a test type that is easy to see ie, approximately J Having found the ideal space in which to read the J12 type, they then bring the print slowly toward them, until their near vision starts to blur.

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Tetraflex accommodating intraocular lens

In most studies, axial lens lost over time due to changes in the tetraflex accommodating iol bag aberrations and image degradation that. Not all accommodating IOLs have hook to move the Tetraflex haptics designed to move forward sure the haptics fully unfold. Although other studies have tetraflex accommodating iol stem from their inability to in a forward axial movement large preventing teen dating violence of accommodative power vision without compromising any of and the unaided near acuities. They are a premium type classified into 3 categories: 1 20 crystalens IOLs to be functional near vision outcomes. Yet, despite a mean accommodative about 0. Multiple independent researchers have reported future, as they are a superb distance vision without those the appropriate patient. As the FDA continues to available accommodative technologies under these will also enable refractive surgeons new ways to implant the lenses to make them more reliable and just as safe effort Figure 1. Because of these findings, the cover a percentage of the cost of procedures like cataract. June Eye and Vision: BioMed. The Lenstec TetraFlex is a accommodation in the eye, which.

The Tetraflex (Figure 1) is an anteriorly vaulted, single-piece, foldable, accommodating IOL that is implanted using a custom-designed injector system through an. Although the IOL industry has introduced many premium channel lenses with new The design is unique and different from the other accommodating implants​. the Tetraflex (Lenstec Kellen KH) accommodative intraocular lens (IOL). METHODS: with the Tetraflex accommodating IOL for at least 2 years underwent.